Risk of persistent cranial nerve injury after carotid endarterectomy
Risk of persistent cranial nerve injury after carotid endarterectomy
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DOI：
10.3171/jns.2004.101.3.0445
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发表时间：
2004-09-01
影响因子：
4.1
通讯作者：
Rothwell, PM
中科院分区：
文献类型：
--
作者：
Cunningham, EJ;Bond, R;Rothwell, PM
物体。颈动脉内膜切除术(CEA)后的颅神经损伤，特别是运动神经损伤，可致残，因此应向患者提供有关遭受此类损伤的风险的可靠信息。在已发表的文献中，脑神经损伤的发生率从3%到23%不等，很少有系列的患者在手术前后接受神经科医生的常规检查。作者在欧洲颈动脉手术试验(ECST)中调查了接受CEA的患者的颅神经损伤的风险，这是接受CEA的患者中手术前后进行神经学评估的最大系列。对每个患者进行脑神经损伤评估和记录，并在随机化后4个月和1年的随访检查中发现持续性缺陷。对颅神经损伤的危险因素进行单因素和多因素分析。在接受CEA的1739例患者中，有88例运动性颅神经损伤(5.1%的患者；95%的可信区间[CI]4.1-6.2)。在23例患者中，缺失通过出院得到解决，留下3.7%(95%可信区间2.9~4.7)的患者残留颅神经损伤：舌下神经27例，下颌缘17例，喉返17例，副神经1例，Horner综合征3例。只有9名患者(0.5%；95%可信区间0.24-0.98)在4个月的随访检查中仍然存在缺陷；然而，在随后的随访中，所有持续的缺陷都没有得到解决。只有手术持续时间超过2小时与颅神经损伤风险增加独立相关(风险比1.56，p<；0.0001)。CEA术后运动颅神经损伤持续到出院后的风险约为4%。然而，绝大多数神经缺陷在接下来的几个月里就会解决，永久性缺陷很少见。然而，在患者接受手术前，应告知患者颅神经损伤的风险。
Object. Cranial nerve injuries, particularly motor nerve injuries, following carotid endarterectomy (CEA) can be disabling and therefore patients should be given reliable information about the risks of sustaining such injuries. The reported frequency of cranial nerve injury in the published literature ranges from 3 to 23%, and there have been few series in which patients were routinely examined before and after surgery by a neurologist.Methods. The authors investigated the risk of cranial nerve injuries in patients who underwent CEA in the European Carotid Surgery Trial (ECST), the largest series of patients undergoing CEA in which neurological assessment was performed before and after surgery. Cranial nerve injury was assessed and recorded in every patient and persisting deficits were identified on follow-up examination at 4 months and 1 year after randomization. Risk factors for cranial nerve injury were examined by performing univariate and multivariate analyses. There were 88 motor cranial nerve injuries among the 1739 patients undergoing CEA (5.1% of patients; 95% confidence interval [CI] 4.1-6.2). In 23 patients, the deficit had resolved by hospital discharge, leaving 3.7% of patients (95% CI 2.9-4.7) with a residual cranial nerve injury: 27 hypoglossal, 17 marginal mandibular, 17 recurrent laryngeal, one accessory nerve, and three Horner syndrome. In only nine patients (0.5%; 95% CI 0.24-0.98) the deficit was still present at the 4-month follow-up examination; however, none of the persisting deficits resolved during the subsequent follow up. Only duration of operation longer than 2 hours was independently associated with an increased risk of cranial nerve injury (hazard ratio 1.56, p < 0.0001).Conclusions. The risk of motor cranial nerve injury persisting beyond hospital discharge after CEA is approximately 4%. The vast majority of neurological deficits resolve over the next few months, however, and permanent deficits are rare. Nevertheless, the risk of cranial nerve injury should be communicated to patients before they undergo surgery.